REAGAN'S TWILIGHT -- A special report.; A President Fades Into a World Apart

By LAWRENCE K. ALTMAN

Published: October 5, 1997

In February of last year, George P. Shultz went to visit his old boss, Ronald Reagan, at the former President's home in the Bel Air neighborhood of Los Angeles. He drank tea with Mr. Reagan and his wife, Nancy, and talked a little politics. In all, he stayed perhaps an hour.

That night, Mr. Shultz, the former Secretary of State, received a call from Mrs. Reagan, who told him that ''something poignant happened today that you would like to know about.''

At one point in the visit, Mr. Reagan had left the room briefly with a nurse. When they came back, Mrs. Reagan went on, ''he said to the nurse: 'Who is that man sitting with Nancy on the couch? I know him. He is a very famous man.' ''

It has been almost three years since Mr. Reagan disclosed that he had the memory-destroying neurological illness known as Alzheimer's disease. And if, at the age of 86, the old movie actor still looks the image of vigorous good health, the truth is that the man behind the firm handshake and barely gray hair is steadily, surely ebbing away.

Mr. Reagan still plays golf, works out lightly in his basement and walks amid eucalyptus and day lilies in the parks close to his home. He puts on a suit and is driven to his office in nearby Century City. As he rides the elevators or walks the corridors, he remains the perfect gentleman, sweeping a hand through the air to let a woman pass by. Well-wishers are ushered into the office for the daily meet and greet, and the 40th President of the United States obliges them with a warm welcome and a photo opportunity.

But the raconteur of old, ''the Great Communicator'' of American politics, is mostly silent now. When he speaks, it is usually in clipped phrases -- rarely more than a sentence here or there. He appears to recognize few people other than his wife. And while he gamely returns the nods and salutes of passers-by, on most days Mr. Reagan does not seem to know why they are hailing him -- that for eight years he was the most powerful man in the world.

Mr. Reagan's Alzheimer's appears to be in the middle stages; as it has advanced, he has slipped ever further from public view. But interviews over the last several months with more than 20 people who know him well -- his White House doctors, friends and some of his closest Presidential aides -- provide what is perhaps the most detailed picture yet of the progress of his disease and of his life today.

At the same time, they cast new light on persistent questions about Mr. Reagan's mental state as President, questions rekindled by the disclosure, in November 1994, that he had Alzheimer's. Nearly 70 when he took office in 1981, Mr. Reagan became the oldest President, and throughout his two terms, a series of well-publicized memory lapses and a casual executive style had provoked uncertainty -- even ridicule -- about his mental competence.

Just when the Alzheimer's began can never be known. But while the line between mere forgetfulness and the beginning of Alzheimer's can be fuzzy, a matter of gradation, Mr. Reagan's four main White House doctors say they saw no evidence that he had crossed it as President. They saw and spoke with him daily in the White House, they said, and beyond the natural failings of age never found his memory, reasoning or judgment to be significantly impaired.

Mr. Reagan ''absolutely'' did not ''show any signs of dementia or Alzheimer's,'' said Dr. John E. Hutton Jr., who cared for him from 1984 until the end of his Presidency and remains a close family friend. Extensive mental-status tests did not indicate evidence of Alzheimer's until 1993, more than four years after Mr. Reagan left office, Dr. Hutton said.

Even in hindsight, Mr. Reagan's friends and former aides said that they, too, had seen no hint of the deterioration to come. And while they acknowledged that he had occasional memory lapses as President, especially when it came to names, many said he had had these problems for years, certainly since he was Governor of California, from 1967 to 1974.

Mr. Reagan is thought to be the first President or former President to have Alzheimer's. But the disease -- a form of dementia, or senility, that strikes with increasing frequency as people advance beyond their 60's -- is a growing public health problem in an aging society. While the course of Alzheimer's varies, it is often slow, measured in years; as it advances, abnormal deposits of protein destroy the nerve cells in the brain, obliterating memory. The two approved drugs can do no more than stave off decline for a few months, and only for some people. Ultimately, Alzheimer's is fatal, though many people with the disease die of other causes.

The first significant hints that Mr. Reagan was crossing that fuzzy line into dementia, his doctors said, did not come until September 1992, three years and eight months after he left office. From that point on, they described a gradual descent into bewilderment and forgetting that will be achingly familiar to families and friends of the four million Americans who share his fate.